Welcome to Guidelines for Nurses. This site uses cookies, some may have been set already. If you continue to use the site, we will assume you are happy to accept the cookies anyway. Read about our cookies here..

Symptoms and signs of specific illnesses

Look for a source of fever and check for the presence of symptoms and signs that are associated with specific diseases (see table 2, above)

Management by remote assessment

Management according to risk of serious illness

Healthcare professionals performing a remote assessment of a child with fever should seek to identify symptoms and signs of serious illness and specific diseases as summarised in tables 1 and 2

Children whose symptoms or combination of symptoms suggest an immediately life-threatening illness should be referred immediately for emergency medical care by the most appropriate means of transport (usually 999 ambulance)

Children with any ‘red’ features but who are not considered to have an immediately life-threatening illness should be urgently assessed by a healthcare professional in a face-to-face setting within 2 hours

Children with ‘amber’ but no ‘red’ features should be assessed by a healthcare professional in a face-to-face setting. The urgency of this assessment should be determined by the clinical judgement of the healthcare professional carrying out the remote assessment

Children with ‘green’ features and none of the ‘amber’ or ‘red’ features can be cared for at home with appropriate advice for parents and carers, including advice on when to seek further attention from the healthcare services

Management by the non-paediatric practitioner

Clinical assessment

Management by a non-paediatric practitioner should start with a clinical assessment. Healthcare practitioners should attempt to identify symptoms and signs of serious illness and specific diseases as summarised in tables 1 and 2

Management according to risk of serious illness

Children whose symptoms or combination of symptoms and signs suggest an immediately life-threatening illness should be referred immediately for emergency medical care by the most appropriate means of transport (usually 999 ambulance)

Children with any ‘red’ features but who are not considered to have an immediately life-threatening illness should be referred urgently to the care of a paediatric specialist

If any ‘amber’ features are present and no diagnosis has been reached, provide parents or carers with a ‘safety net’ or refer to specialist paediatric care for further assessment. The safety net should be 1 or more of the following:

providing the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be accessed

arranging further follow-up at a specified time and place

liaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further assessment is required

Children with ‘green’ features and none of the ‘amber’ or ‘red’ features can be cared for at home with appropriate advice for parents and carers, including advice on when to seek further attention from the healthcare services

Tests by the non-paediatric practitioner

Children with symptoms and signs suggesting pneumonia who are not admitted to hospital should not routinely have a chest X-ray

When a child has been given antipyretics, do not rely on a decrease or lack of decrease in temperature to differentiate between serious and non-serious illness

Use of antibiotics by the non-paediatric practitioner

Do not prescribe oral antibiotics to children with fever without apparent source

Give parenteral antibiotics to children with suspected meningococcal disease at the earliest opportunity (either benzylpenicillin or a third-generation cephalosporin)

Admission to and discharge from hospital

In addition to the child’s clinical condition, consider the following factors when deciding whether to admit a child with fever to hospital:

social and family circumstances

other illnesses that affect the child or other family members

parental anxiety and instinct (based on their knowledge of their child)

contacts with other people who have serious infectious diseases

recent travel abroad to tropical/subtropical areas, or areas with a high risk of endemic infectious disease

when the parent or carer’s concern for their child’s current illness has caused them to seek healthcare advice repeatedly

where the family has experienced a previous serious illness or death due to feverish illness which has increased their anxiety levels

when a feverish illness has no obvious cause, but the child remains ill longer than expected for a self-limiting illness

If it is decided that a child does not need to be admitted to hospital, but no diagnosis has been reached, provide a safety net for parents and carers if any ‘red’ or ‘amber’ features are present. The safety net should be 1 or more of the following:

providing the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be accessed

arranging further follow-up at a specified time and place

liaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further assessment is required

Children with ‘green’ features and none of the ‘amber’ or ‘red’ features can be cared for at home with appropriate advice for parents and carers, including advice on when to seek further attention from the healthcare services

Referral to paediatric intensive care

Children with fever who are shocked, unrousable or showing signs of meningococcal disease should be urgently reviewed by an experienced paediatrician and consideration given to referral to paediatric intensive care

Give parenteral antibiotics to children with suspected meningococcal disease at the earliest opportunity (either benzylpenicillin or a third-generation cephalosporin)

Children admitted to hospital with meningococcal disease should be under paediatric care, supervised by a consultant and have their need for inotropes assessed

Advice for home care

Care at home

Advise parents or carers to manage their child’s temperature. Advise parents or carers looking after a feverish child at home:

to offer the child regular fluids (where a baby or child is breastfed the most appropriate fluid is breast milk)

how to detect signs of dehydration by looking for the following features:

sunken fontanelle

dry mouth

sunken eyes

absence of tears

poor overall appearance

to encourage their child to drink more fluids and consider seeking further advice if they detect signs of dehydration

how to identify a non-blanching rash

to check their child during the night

to keep their child away from nursery or school while the child’s fever persists but to notify the school or nursery of the illness

When to seek further help

Following contact with a healthcare professional, parents and carers who are looking after their feverish child at home should seek further advice if:

the child has a fit

the child develops a non-blanching rash

the parent or carer feels that the child is less well than when they previously sought advice

the parent or carer is more worried than when they previously sought advice

the fever lasts longer than 5 days

the parent or carer is distressed, or concerned that they are unable to look after their child

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

This summary provides useful information on weight loss in the early days of life and faltering growth after the early days of life. Interventions, monitoring, referral, and organisation of care are covered.